Reversal Theory States in Smoking Cessation among Adolescents

Reversal Theory States in Smoking Cessation among Adolescents Rebecca Burris, PhD, RN Arkansas Tech University Russellville, Arkansas

Funded by: • American Nurses Foundation • University of Arkansas for Medical Sciences Graduate Student Research Funds

Goal • To learn about the process of smoking cessation in adolescents

Purpose of the Study • To predict whether adolescents who are trying to quit smoking will lapse during highly tempting situations as predicted by psychological states described in Reversal Theory.

Specific Aims • To identify psychological states • To examine the relationships between psychological states, lapse, and cigarette availability • To predict lapse from psychological states and cigarette availability

Hypotheses • When tempted to smoke, adolescents in the paratelic state are more likely to lapse than adolescents in the telic state. • When tempted to smoke, adolescents in the negativistic state are more likely to lapse than adolescents in the conformist state.

Hypotheses (con’d) • Cigarette availability is not related to lapse for adolescents in the telic state. • When cigarettes are readily available, adolescents in the paratelic state are more likely to lapse than when effort is required to obtain cigarettes. • When tempted to smoke, adolescent’s psychological state and cigarette availability predict lapse.

Significance • Tobacco use is the leading preventable cause of death in the U.S. • 5 million teens expected to die as a consequence • Smoking prevalence among teens has increased to 36% • 80% of first tobacco use occurs in adolescents under 18

Significance (con’d) • Many teens realize they are addicted • Many teens try to quit; 60% have tried in last year • 40% quit for a week or less • 28% of those who quit for as long as 6 months resume smoking within a year • Current approaches are not successful

Theoretical Framework Reversal Theory Pairs of Metamotivational States

Telic/Paratelic

Negativistic/Conformist

Mastery/Sympathy

Autocentric/Allocentric

Telic/Paratelic Pair • • • •

Goal-oriented Serious-minded Prefer low arousal Future oriented

• • • •

Activity-oriented Playfulness Prefer high arousal Here and now oriented

Negativistic/Conformist Pair • Rebellious • Oppositional • Defiant

• Conforming • Responsible • Keeps the rules

Sampling Plan • • • •

ages 14-19 high school students convenience N=62

Eligibility Criteria • Self-reported daily smoking during the previous 30 days • Self-reported smoking for at least one year • Recent participation in smoking cessation program • Decision to quit smoking

Preliminary Studies • Pilot test of demographic questionnaire: N=6 • Pilot test of Metamotivational State Interview: N=2

Methods • • • •

Descriptive study In-depth semi-structured interviews Demographic questionnaire - 40 items Metamotivational State Interview

Demographic Questionnaire • • • • •

40 items Content similar to national surveys Age, gender, educational characteristics Smoking habits 5-7 minutes to complete

Metamotivational State Interview • Semi-structured interview • 45-60 minutes to administer • Interrater reliability: 74% - 88% in previous studies • Interrater reliability for this study: 90%

Metamotivational State Interview (con’d) • • • • •

Transcribe the interview Divide episode into coding units Code the telic/paratelic dimension Code the negativistic/conformist dimension O’Connell, Potocky, Cook, & Gerkovich (1991)

Smoking Cessation Classes • 8 Arkansas high schools participated • 2 classes presented • Taught by Senior Nursing Student and Health Educators • Content from American Lung Association

Data Collection • • • • •

Interviews conducted at high schools In private Tape-recorded Transcribed verbatim Transcriptions reviewed by investigator

Reliability • Random sample of 10 coded transcripts • Coded by Dr. O’Connell • 90% interrater agreement based on first coding

Data Management • Data entered into Microsoft Access • Analyzed in SPSS

Demographic Data Descriptive Statistics Inferential Statistics Mean Range Standard deviation Frequencies Proportions

Chi-square Logistic regression

Sample • N=62 • 8 Arkansas high schools – – – –

344 - 1,501 students In towns with populations 1,148 - 61,829 50.9% male 87% white, 8.7% black

Sample (con’d) • Subjects (N=62) – – – – – –

Age X=16.7 (SD=1.68) Grade level X=10.9 (SD=1.14) 26 (42%) male 54 (87%) white 46 (74%) participated in extracurricular activities All but one attended the smoking cessation class

Smoking History • • • • •

55 (89%) trying to quit 40 (64%) still smoking some 22 (36%) “ex-smokers” 58 (94%) smoked 1 year or longer 52 (84%) smoked every day

Reversal Theory Context • 49 (79%) said smoking is relaxing • 15 (24%) said smoking is fun • 11 (18%) said smoking is exciting

Analysis • 14 subjects had not smoked to the time of the interview • 48 subjects had smoked at least once • Data analyzed 3 ways – N=110 all tempting episodes – N=62 (14 resist episodes from those who had not smoked and 48 lapse episodes from those who had) – N=96 (resist and lapse episodes from those who had smoked)

Results • T-test and Chi-Square to test for differences between resisters and lapsers (p=.05) – No statistically significant differences in age, grade level, or age at first cigarette – Race, gender, education, employment of mother and father, and relationships with teachers, coaches, parents, and other relatives who smoke – Experience with previous attempts at quitting

Results (con’d) – Resisters more likely to make better grades (²=11.2, df=5,p=.048) – Resisters less likely to have friends who smoke (²=5.23,df=1,p=.022) – Resisters less likely to have neighbors who smoke (²=6.46,df=1,p=.011)

Logistic Regression Analysis *p